Filling the insurance gap for working people

Many uninsured people earn a modest hourly wage working for small businesses that cannot afford to offer group major medical coverage.

But in several regions of Texas, groups are working to put together “3-share plans” in which the employee, employer and a public fund pitch in.

It’s more limited than most private insurance, but according to the executive director of the state’s only up-and-running 3-share plan, workers who’ve been getting by on emergency room visits welcome whatever they can get.

Jim Rodriguez, executive director of the active Galveston 3-Share Plan, and Karen Love, executive director of the Harris County Healthcare Alliance, which is developing a 3-share plan, spoke Thursday at the San Antonio Hispanic Chamber of Commerce Healthcare Summit.

It hasn’t been as hard as one might imagine to persuade providers to participate in the plan, Love said, because “by and large, they’re seeing these people with no insurance now.”

The provider network is key, said Rodriguez, who works for the University of Texas Medical Branch, and the Galveston plan works because UTMB was able to recruit “a lot of senior physicians.”

To draft the plan, they looked to Muskegon, Mich., which implemented the first 3-share plan in the country, Rodriguez said, and also put together a focus group to figure out employer and employee priorities.

The Galveston plan includes coverage for 12 mental health visits per year, despite the low ranking the focus group gave mental health as a priority.

UTMB experts know that people with mental health problems tend to have other health problems as well, Rodriguez said, so in the difficult process of what to leave in and out, they left some mental health coverage in.

The Galveston plan also has a $250,000 lifetime limit, and Rodriguez said employers recognized how small that amount really is.

“Employers would say, ‘That’s not much.’ But employees would say, ‘I’ll take it – I’ll take anything.'”

The argument for putting public funds into insuring people is that when people are able to see doctors and manage their health, they ultimately cost the system a lot less in both uninsured emergency room visits and better health overall, the speakers said. Others argue that benefits will help reduce costly employee turnover.

3-share plans are also under development in Dallas, Central Texas, El Paso and the Brazos Valley.